The main causes for health care spending waste are overtreatment of patients, the failure to coordinate care, and the administrative complexity of the health care system. In this regard, healthcare is typically administered in a piecemeal fashion via a process that is typically initiated by a patient's self-assessment or self-diagnosis. Depending on the individual patient's judgment, the patient will typically seek treatment at a traditional “brick and mortar” facility, whether it be a doctor's office, clinic, hospital/emergency room, or the like. Alternatively, the patient may forego or delay seeking treatment, possibly due to medical ignorance, fear of seeking healthcare, cost constraints or some other factor that in turn causes a medical condition to substantially worsen which could have otherwise been prevented or more easily treated.
To the extent care is ultimately rendered, there is often a disconnect regarding the continuum of care that is administered to a particular patient. In this regard, often times a patient is treated by multiple healthcare providers that are often not in communication with one another and do not have a comprehensive assessment of the patient's condition. For example, a patient may have a regular physician overseeing the medical management of one or more chronic conditions but at the same time intermittently be treated by other healthcare providers for unrelated or acute conditions that may not take into account all of the different health issues affecting that particular patient, such as any medications the patient may be on, the patient's pre-existing health conditions, most recent lab results, and the like.
As such, the delivery of healthcare becomes uncoordinated and causes critical patient data to become fractured and decentralized, and much less considered in its entirety when treatment options are considered. Moreover, because any healthcare that is ultimately delivered is through “brick and mortar” facilities, there is often times an overutilization of healthcare resources, and in particular physician examination time. With respect to the latter, it is well recognized that many office and clinic visits, and especially visits to emergency rooms, are unnecessary, wasteful and add to the expense of healthcare when many times such conditions can be easily addressed in a home-based setting or whereby care is delivered directly to the patient outside of a “brick and mortar” healthcare facility.
The aforementioned problems are exacerbated when multiplied over a large patient population, and in a particular patient population having a significant prevalence of medical conditions that require significant healthcare resources to address. Such chronic, high-maintenance conditions, such as diabetes, cancer, asthma, and heart disease, thus produce patients that are often times no longer treated as individual patients, but rather a patient that falls within a sub-category of high cost, complex disease management.
In the healthcare industry, disease management at such level is typically addressed by stratifying the population (population management) in order to target interventions in the most efficient and cost-effective way. In the population management process, however, there is no focus on treating the patient as a whole. For patients in a specific disease registry, the focus is on achieving clinical goals set at the registry level. The patient is, however, not at the center.
A highly successful disease management program should be designed to set patient-specific goals for one or more comorbidities but at the same time have all the operational efficiencies of population management (i.e., several disease registries based on comorbidities). Such program should further provide for coordinated care amongst all healthcare providers treating a given patient. Ideally, a continuum of care would be provided that prevents the aforementioned drawbacks associated with multiple healthcare providers treating the same yet not having access to medical records and other vital medical information regarding the overall health of a client, and not to mention the most current up-to-date health information that is updated on a periodic basis.
In addition to the foregoing, any such successful disease management program should be operative to conserve resources, and wherever possible minimize the current wasteful practices associated with “brick and mortar” delivery of healthcare. Instead, methods for administering care should provide for home-based healthcare programs that not only ensure that a high-level of quality care is provided but also minimize the utilization of healthcare resources, particularly at “brick and mortar” facilities, that in turn conserves those resources for patients with health conditions that warrant more aggressive levels of care.